Provider Demographics
NPI:1922852664
Name:KIRBY, CARA SUSAN
Entity Type:Individual
Prefix:
First Name:CARA
Middle Name:SUSAN
Last Name:KIRBY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:255 WINTERS DR
Mailing Address - Street 2:
Mailing Address - City:MASTIC
Mailing Address - State:NY
Mailing Address - Zip Code:11950-1001
Mailing Address - Country:US
Mailing Address - Phone:631-897-6707
Mailing Address - Fax:
Practice Address - Street 1:255 WINTERS DR
Practice Address - Street 2:
Practice Address - City:MASTIC
Practice Address - State:NY
Practice Address - Zip Code:11950-1001
Practice Address - Country:US
Practice Address - Phone:631-897-6707
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-17
Last Update Date:2024-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist